In the Spotlight

By David Grotto, RD, LDN

I just finished watching the four-part HBO series called The Weight of the Nation and found it so compelling and frightening that I sat for four consecutive hours to watch it. My conclusion? Watching The Weight of the Nation can cause obesity!

Sounds silly, but one of the points made in this fairly well-balanced documentary about the plague of obesity in this country is that just about anything we do as Americans can be linked to our current obesity epidemic. Regardless of where we live, how educated we are, or how much money we have, obesity is an equal opportunity offender. The documentary shares many alarming facts, such as the cost of obesity, which is bankrupting our nation to the tune of $150 billion a year and that watching television or more “screen” time (of any type) has been linked to obesity.

Thinking about putting a television in the kid’s room? Think again. Children are much more likely to become obese by having a TV in their room than not having one. And it’s not just the mere act of watching a “screen” that blocks us from healthy behaviors, like moving more and engaging in physical activity, but that this low-calorie-burning “activity” is also compounded with titillating messages enticing us to eat more of the type of foods that fuel obesity. I think that’s what they call a “vicious cycle.”

Though there were inspiring stories of how individuals, companies, and entire communities made positive changes to improve health, the documentary in general was a little short on solutions, especially on the home front. So I thought it might be helpful to discuss two major themes of obesity and start a conversation about possible solutions. Sound good? Oh yeah, I’m expecting you to add your own ideas of what has worked for you, your community, or workplace!

Calories in. Problem?

Access to food. Not only are we bombarded with thousands of food choices every day, but we don’t have to travel far to fulfill any choice we want to act on. We have changed from hunter-gatherers to sloth-like seeker-orderers. We seek out food and place our order and the only hunting we do is for an open table. Thomas Farley, MD, MPH, Commissioner of the New York City Department of Health and Mental Hygiene points out in the documentary that we are not genetically programmed to turn down calories when they are presented to us. Apparently, part of our existing hard wiring that dates back from the early days of man has programmed us to seek out high-calorie foods that we could gorge ourselves on to tide us over until we bagged another unfortunate beast.

Possible Solutions?

Sin Tax. Make foods that are associated with obesity have a higher price tag for the consumer while making nutrient-rich, lower-calorie foods more affordable. Ironically, in poorer neighborhoods, you can purchase more calorie-rich and nutrient-poor type foods for the dollar than you can healthy foods. And regardless of neighborhood, it costs more to buy a healthy salad and bottled water at a fast food restaurant than it does to purchase a burger and fries. This “sin tax” was instrumental in reducing cigarette smoking – it might be worth a try.

Make junk food harder to find. Redesign the layouts of grocery stores and cafeterias. Make good-for-you-foods easier to find and make sugar-sweetened beverages and fatty packaged pastries something you have to go on a treasure hunt for. Relegate obesity-promoting foods to bottom shelves and do not give them prime real estate.

Problem? Advertising of unhealthy foods, especially to children.

In part three of the series, called “Children in Crisis,” William Dietz, MD, PhD, Director of the Division of Nutrition, Physical activity and Obesity for the Center for Disease Control and Prevention stated that 1.5 billion dollars a year is spent on the marketing of food products to children. Seventeen leading food companies have formed the Children’s Food and Beverage Advertising Initiative (CFBA), which pledged to advertise only “better for you” foods to kids. In 2010, First Lady Michelle Obama encouraged not just a limit on advertising unhealthy foods but a simultaneous increase in the marketing of healthy foods to children. However, though improved, marketing of unhealthy foods to children remains a problem and warrants industry-adopted standards of what constitutes “healthy”. These industry-wide standards should also include stricter guidelines on label claims with hopes of eliminating confusion for the consumer.

Possible solutions?

No marketing of unhealthy foods, period! This sounds great at first glance, but what makes a food healthy or unhealthy? Do sugary sweetened cereals contribute to obesity? If so, how much do you have to eat to be concerned? What constitutes “sugary”? Many companies have already reduced sugar and increased whole grain in several of the cereals kids love and we need to encourage companies to continue to make products that are healthier for kids that they will still eat. Besides, cereal also brings along with it all the nutrition you get from milk. I would agree that sugar-sweetened beverages and treats with no redeeming health attributes should be banned from advertising.

Ban unhealthy portion size advertising. I think anything with the word “monster,” “jumbo,” “enormous,” “gut-buster,” or any such verbiage that describes huge portion sizes should not appear in advertising. I do think calorie, saturated fat, and sodium levels should be proudly displayed in all food and beverage advertisements. You want to promote a big gulp? Great. Also post what the cost of gastric bypass surgery is these days. You want to promote overeating on a food show? Great. Also post a Surgeon General’s warning that this type of behavior may also cause diabetes, contribute to heart disease, lead to erectile disorder…you get the idea.

Calories out: Problem?

Physical activity is not required in all schools! I was shocked to learn in the documentary that state and local governments, NOT federal government, mandates whether physical activity is offered in schools. What?

Solutions?

Make physical activity mandatory for all grade levels and provide adequate funding for equipment, organized sports, and facilities. Sounds simple here too, but this requires money and also a change in thinking. I was elated to see that one of the experts in the series made the connection between physical activity and improved learning. State of Texas Comptroller Susan Combs looks at the investment in physical activity in schools and the workplace as a method of controlling health care costs.

Problem? Many communities do not provide safe locations and facilities for physical activity.

Solutions?

Make federal funding of healthy communities a priority. The CDC gave 17 million dollars to the 2nd fattest city in America (Nashville) to improve city bike and walk ways among other projects to get citizens to move. They have also implemented exercise programs for their police and fire departments to help them get and stay in shape. Many communities do not have adequate sidewalks, ample lighting, or parks and recreational facilities to encourage their citizens to get moving. What wasn’t discussed was the cost of park district or health club memberships. Financial barriers need to be knocked down between those who want to be physically fit and the facilities that can help make that happen.

What was abundantly clear after watching this series is that obesity exists for many reasons, and there isn’t one solution. It will take the collective minds and souls of industry to put the health needs of consumers first as a vehicle for driving creative product development that is still profitable; policy makers, to do what’s best for its citizens instead of special interest groups; and adults, to model for their children by making healthier choices and choosing to move. I’d love to talk to you more but I think it’s about time to get up and move. Who’s with me?

In conjunction with the HBO documentary “Weight of the Nation,” WebMD is examining some of the issues surrounding the nation’s obesity crisis. In this piece, 14-year-old Kaelan Guetschow and his father, Bill, talk with WebMD’s Valarie Basheda about confronting Kaelan’s weight problems head on. Kaelan and his family, who are featured in “Children in Crisis,” decided to enroll Kaelan in an obesity prevention program at the University of Wisconsin in 2009. He has lost weight since last summer while growing several inches, along with lowering his percentage of body fat.

Question: Kaelan, you’ve had some great success in a short time. What is motivating you?
Kaelan: I got tired not liking who I was and my parents kind of intervened too. I just feel a lot better than I felt before. I really like that feeling. I’m not as tired, I don’t feel as stressed, I feel more relaxed.

Bill: We did have some concerns about 3 years ago where we were just noticing that he … was growing up and putting on a little bit of weight and growing taller, and that pudginess would disappear so to speak. We just noticed at a certain point that wasn’t happening. It wasn’t appearance so much as that his motivation to be active was low… his default mode was not to go out and play but to sit on the couch and not move.

Kaelan: I have never been very good at sports. I think that’s been part of this thing. I’m good at my games I can play on my computer and on my TV. Then there were other things beside sports that I had also tried [such as exercise machines]. I never got into it until I went to the fitness clinic. I just got a new bike set…I have been going outside a lot more.

Question: What changes have you made at home to your diet?
Bill: Self-regulation for him was difficult… Knowing when he was full… I think all of us needed to relearn a little bit about portion control. One of the things the fitness clinic has done for us is we’ve worked with a dietitian. She’s really helped us understand what is a normal portion for the average person and it’s usually about half of what we have. This is what you would typically be served in a restaurant and this is what you actually need. That was actually eye opening.

Question: Kaelan, do you have any new favorite foods?
Kealan: I’m still a picky eater but I’m not as picky as I used to be. Like mushrooms. If it’s kind of mixed in and I can’t tell, I’ll eat it. If they’re just alone like big pieces on a salad I would not eat it.

Bill: His favorites are still the typical American kid favorites, pizza and burgers and things like that. It’s now once-in-a-while-food instead of all-the-time-food.

Question: Did you change what you drink?
Bill: We did have a habit of having juice in the house and the documentary really hammered that home for us…We didn’t necessarily make the connection until seeing in the film where all those various juices, how many tablespoons of sugar they contained. We’ve already tried to minimize those things to a certain extent.

Kaelan: I used to really not like milk unless it was on my cereal. I started to drink milk now, which has been part of it instead of having those sugary drinks.

Question: The film cites a statistic that only 10% of parents seek help for their overweight kids. Bill, what motivated you to get help for Kaelan when so many others don’t?
Bill: You don’t want to necessarily admit that this is an issue. I think both Kristin [Bill’s wife] and I have struggled with weight a bit. At the time, when I was Kaelan’s age I had similar issues. I remember at the time people telling me, family members, ‘Don’t worry about it.’ I actually brought it up… It’s hard to admit that you need help with something and it’s hard to admit that those concerns are real.

There were a lot of other factors that the film doesn’t really touch on. Kaelan has epilepsy and one of the potential side effects of some of the medications he has been on is weight gain. With Kaelan having been diagnosed with epilepsy at age 4, we were pretty comfortable with the idea of seeking medical help when necessary…  As parents you feel guilt about a lot of things a lot of a time. It’s tough for people to admit that their habits might be causing issues for their kids. It was tough for us, but we realized it was better to confront the problem then pretend the problem didn’t exist.

Question: Kaelan, how did you feel when your parents talked to you about your weight?
Kaelan: I really want just to try and work this out by myself. I don’t like them telling me how to do it.

Bill: What we’re trying to ultimately instill in him is a sense of regulation and knowing what types of food his body needs and what his body needs in terms of exercise. At some point your kid is going to have to be off on his own someday and make these decisions for himself … and you hope you’ve done a good enough job helping him make the right decisions.

Kaelan: I think the fitness clinic has been helping me to make those right decisions. Not just sitting down but what exercises we can do, how to motivate yourself, how to eat, what’s going on in your body right now that’s making you gain weight or lose weight.

At one point in the movie, Kaelan undergoes a body scan that shows he has been successful in reducing his percentage of body fat and increasing his muscle mass.

Kaelan: Some of my motivation came from that scan in the movie. That I was getting somewhere with some of this…that I didn’t have to give up, that I was heading in the right direction.

Question: Kaelan, how do you feel about so many people seeing your story?
Kaelan: I’m just starting to realize now how many people are going to see it… The scariest part is that my whole school is going to see it. I don’t care about the people who don’t know me. I care at the school because I have to sit next to them every day.

Bill: If us being part of this project can help someone in a similar situation take similar steps we did, we thought, ‘Alright we’re going to do this.’ We knew the risks going in… We’re putting ourselves out there for the whole world to see. I’m very proud of him to make this decision to be part of this.

Question: Kaelan, what advice do you have for other teenagers in the same situation?
Kaelan: Seek help and if that’s not an available resource, try and watch what you’re eating, try and do more exercise and never give up. If you’re really motivated and you try hard, you really will succeed.

In conjunction with the HBO documentary “Weight of the Nation,” WebMD is examining some of the issues surrounding the nation’s obesity crisis. In this piece, WebMD expert pediatrician Hansa Bhargava, M.D., talks about some of the myths she hears from parents about children and weight. Bhargava is the spokesperson for WebMD FIT and Raising FIT Kids, which are dedicated to raising healthy children.

Did you know that this current generation of kids may be the first to have a shorter life expectancy than their parents? Think about that. We may outlive our children.

It’s a sobering fact. As a pediatrician, I really worry about this. Recently, I saw a 10-year-old boy in my office for leg pain. He was overweight and limping. Many parents would think a 10-year-old boy with a limp had an injury from a soccer game or maybe sprained his ankle while playing basketball. Unfortunately, his problem was much worse: he had a hip fracture. Can you imagine a 10-year-old boy with a hip fracture? Most of us think that this happens to older people. But now, because of excess weight, we are seeing more and more kids with this type of problem, as well as diabetes, liver disease, and high blood pressure.

As a mom, I’m really concerned, too. More than a third of our kids are already overweight or obese, as are adults. In less than two decades,  42%  of our nation will be obese. Despite these stark numbers, I still talk to many parents who are in denial about the severity of the problem and how families can get healthier. Here are some of the myths I encounter with parents:

* Juice is good for you. NOT TRUE all the time. Juice often contains as much sugar as a soda. Get rid of any sugary beverages  in your kitchen, and limit juice. Kids should drink milk or water.

* It’s ok for children to have a TV in their bedroom. NOT TRUE. This bad habit has been linked to childhood obesity in many studies. Get rid of it, and your child will be forced to move around. As an added bonus:  no unhealthy food ads for them to watch.

* It’s okay for parents to eat junk foods as long as the kids aren’t.  NOT TRUE. If you or another caregiver is eating badly, the kids will learn that too. Actions speak louder than words, so remember to practice healthy habits, and the kids will too!

* Kids don’t want to do things as a family. NOT TRUE.  Many studies have shown that family time can lead to happier, more grounded, less overweight kids.

When you combine a bad diet, food company marketing ($1 billion a year toward kids), kids being on media seven hours a day, and a lack of exercise and sleep, it’s no wonder we are where we are.We need to make a change!

Prevention and healthy habits can fuel that change. As a working mom, I know how crazy life can get! My six-year old twins are always challenging me: “Mom, do we have to eat this?” Or when I pick them up from school: “Please, can we go to the donut shop? I’m so hungry!” It’s hard to resist their pleas, but it is the most important thing that you can do. We need to help our kids be at a healthy weight so that they don’t get diabetes, hip fractures, and other diseases.

Remember, it’s not too late. As moms and caregivers, we can make a difference. For the sake of our children, lets do it!

In conjunction with the HBO documentary “Weight of the Nation,” WebMD is examining some of the issues surrounding the nation’s obesity crisis. In this piece, 41-year-old Gigi Filippi talks with WebMD’s Valarie Basheda about how she confronted her weight problems. Since the documentary was filmed about a year ago, Gigi has lost more than 100 lbs. and plans to lose another 120. Her 16-year-old daughter has also lost 100 lbs. Gigi also started a wellness committee at the call center where she works that offers challenges on food and fitness.

Question: When did your struggles with weight begin?
Gigi: When I was really little I did not have a weight problem. By the time I was 8 both my parents were dead….. I can actually pinpoint it to the age 8 when my father passed away…It’s been a progression over the past years and has been worse and worse. To be 40 years old and 400 pounds last year, there were a lot of issues somewhere….  I had tragedy after tragedy in childhood I searched in the wrong places for that void to be filled in life.

My greatest support is in the workplace. I told the owner that she’s saved my life. I will always credit the environment she’s created here in the work place to give the confidence that I can do this myself.

Question: Did something happen to prompt you to start losing weight?
Gigi: Something did happen. I had to go to Vegas for a convention. The flight was full coming back. I was stuck in the very back row on the airline. They were asking for volunteers to get off the plane because the plane was too heavy. A man was sitting next to me, he got off the plane, he changed his whole flight because he said I was too heavy to sit next to. At that point, I was just like, “I don’t want to live like this, I have to fix what’s broken in me….

It was my lifestyle, it was the choices that we made, being a single mother, working all the time, trying to make the dollars stretch and feed her, feed me, and the choices were all wrong…..  My daughter was miserable, she was starting high school. I had so much guilt on me… I’m very strong in my faith. Every night when I prayed, I would pray I would not die in my sleep. I was so afraid I was going to die.

Question: How did you get started?
Gigi: If you put your mind to it, you have to do it for yourself, you have to do it for your family. You have to start, and as a female, and as a single mother, for some reasons it’s embedded in us that if we take the time to take care of ourselves, it’s selfish. Yes, it is cheaper to go through the McDonalds drive through, and yes it is cheaper to make processed foods. It’s cheaper now, but the end result…has a consequence, either immediately or down the road.

I take time to invest what I put in my mouth because I’m investing in myself and the future of my daughter. I have learned to find a way. We cut cable out. We don’t need cable, if that’s taking away from us eating healthy, then cable is the first to go. If we have time to sit around and watch TV, we have time to be exercising.

You have to find what your weakness is. What are you spending you money on, what areas can you cut from. Friends ask, “How are you doing this?” It’s always they can’t, can’t can’t …. You have to learn to get out of your mind set and believe in yourself and have the determination that you can do this. If you want it, it’s achievable and it’s necessary.

Question: What other changes have you made?
Gigi: I don’t try and find the closest parking spot anymore. It’s nice to feel I can walk from point A to point B now. I’m getting a little bit of exercise in. I don’t have that fear anymore that I am going to have a heart attack. I don’t have that fear that I am going to drop dead if I walk a little….

I’ve learned through this whole process that if I don’t plan what I’m going to eat I’m setting myself up for failure. Sunday I prepare meals for the whole week. I bring my lunch every day…. I cannot allow any excuses. I’ve also learned where I can go to eat that has healthier options. When groups of people go out, it’s not about the food, it’s about the fellowship.

We eat spinach 2 or 3 times a day. We joke that we eat like little old ladies. Fish and spinach have become our best friends and we really enjoy it. For a 16-year-old-to ask me for fish and spinach I’m all on it. She has always loved fruits and vegetables and I felt so guilty before our weight loss because I would tell her I just didn’t have the money. Now, we do it.

I even got rid of my SUV and got a 2-door car to save on gas so I would have extra money. So when I say I’m serious about this, I’m serious. I know because I live it.

As a female, what I can’t stress enough is that ok to take out the time out yourself. If you’re a struggling single mother, as I have been for 16 years, there is a way out of this. You have to take care of yourself to take care of your family.

Question: What’s the best change that has come out of your weight loss so far?

Gigi: I’m a stronger person, the healing process has started after 40-plus years. I feel like a different person mentally, physically and emotionally and I fell like I’m able to start living again and I can be a part of every day society.

In conjunction with the HBO documentary “Weight of the Nation,” WebMD is examining some of the issues surrounding the nation’s obesity crisis. In this piece, WebMD Senior Writer Dan DeNoon talks to CDC Director Tom Frieden, who appears in the documentary series. A third of Americans are currently obese, and that number is expected to rise to 42% by 2030.

Question: What caused the obesity crisis?

Frieden: Nobody could have predicted that obesity would get as bad as it is. Today, if you go with the flow you will end up overweight or obese — as two thirds of Americans do.

We are not certain what caused it. In the simplest terms, I believe, it is more about eating more than about getting less physical activity. We eat about 250 calories more a day today than we did 20 years ago. That is a reflection of everything from the availability of food, the decreasing cost of some very unhealthy foods, to the increasing portion size. It is a very different food environment now than the food environment we evolved to suit.

We did engineer most physical activity out of most of our lives. From car culture, to less leisure and more screen time — not just TV but also computers and handheld devices — we have become more sedentary.

Half as many kids walk to school as used to. And on any given day, more than a third of kids and adolescents eat fast food. That wasn’t the case when we were growing up.

I don’t think we can turn back the clock on changes in our society that reflect our increasing desire for convenience, whether in food or in transportation. Whatever caused us to become so obese, it is a serious problem. Obesity leads directly not only to diabetes, but to cancer, stroke, heart attack, and depression.

Question: The HBO series also points to much of the progress that has been made in fighting obesity. What steps can we take?

Frieden: What someone does to be healthy or not is their responsibility. But we as a society have a responsibility to do things that will help them when they make those decisions to be healthier.

• For yourself and your family, figure out things you enjoy doing that are physically active. Play ball with kids, or bike, or take walk in the evening with your spouse. If it is a chore, it is going to be hard to keep up for years and years. Being physically active is really important.

• You don’t want to be on a diet you see as a punishment. You want to seek out foods you enjoy that are healthy. Think about moderation in foods that are less healthy, and heavy up on fruits and veggies that are healthy.

• If you have to snack, snack on stuff that is healthy, whether celery or red peppers or Wheat Chex. And when you drink, don’t forget to always have a glass of water, too, that will fill you up with something that is less sweet and tastes good.

• On the community level there are a lot of things we can do. We want to make sure kids walk or bike to school healthily. We want to make sure phys ed classes are better than they are. In studies of physical education classes, kids are active only a third of the time. They should be active from the time they walk in the door until they leave. We can do this without spending a penny.

• People around the country are figuring out ways to create and to use parks. Parks are good not only for health but for safety and social cohesion.

• In work places, employers are recognizing that it’s good for people to get active. If health insurance is major cost, let’s figure out ways to get employees active. It is something that will promote productivity.

• Health-care providers can promote everything from breast feeding to counseling patients.

• Child care is another area where we have seen tremendous progress. We’ve begun to make sure kids get active and not stuck in front of a TV.

Question: While we were doing this interview, you said you had eaten a piece of cheesecake that morning. How do you stay fit?

Frieden: I have been steeped in these issues for years. But in my own life I really try to build in physical activity. If I can’t get to the gym I walk up the stairs. I’m on the 12th floor. I do weigh myself regularly. And if it’s creeping up there I know I need to do some course correction, maybe cut down on portion size for a while.

I had some cheesecake this morning because I was doing well. You don’t have to give up things you love. Just make sure you get healthy things as well.